pears to consider "most disgusting and dangerous," though (strange to say!)" accompanied with an appearance of satisfaction, not unlike that of the courtiers of Louis XIV. who, by a strange perversion of sentiment and loyalty, were not only proud to be the favourites of the Grand Monarque, but of being likewise counted martyrs to the same disease with which that personage is known to have been afflicted." It is hardly necessary to say, that we are far from encouraging peculiar practices in medicine. Diseases are so proteiform, and constitutions so dissimilar, that various and often opposite remedies, must be employed in the same complaint. In fact, the great art of medical practice, consists in watching the phenomena exhibited by the constitution and the disorder; and adapting the remedies to the existing state of the case. By the anonymous writer's account, such is not the rule at Bath; for on looking over a file of prescriptions in a chemist's shop there," twenty-eight out of thirty consisted of the blue pill." 13. Ascites cured by Pressure. It is but very seldom that we see abdominal dropsy cured, after the operation of paracentesis. The following case is therefore interesting. "Mary Mattan, 21 years of age, had enjoyed good health, and menstruated regularly till within six months of the date of this report. She entered the Hotel Dieu on the 23d January, 1815. During the preceding half year, and without any known cause, her abdomen daily enlarged in size, without pain or any kind of indisposition. Latterly, her breathing became embarrassed, her appetite depraved, her sleep interrupted, and her spirits depressed. Examined with. care, she presented the following phenomena:-considerable emaciation-abdomen very large, not painful, but offering on percussion, unequivocal fluctuation. Diuretics of squill, nitre, and digitalis purgatives-diluënt drinks. The urine was increased, and the size of the abdomen diminished. But this success was only ephemeral, and the dropsy gaining ground, recourse was had to paracentesis. M. Dupuytren drew off a considerable quantity of limpid serum. The abdomen was then carefully examined, but no viscus could be found organically affected. Resin of jalap and nitre were then administered in a diuretic drink. The secretion of urine increased at first; but the abdomen began to enlarge again, and fluctuation was soon evident. This was on the 20th April. Abdominal compres A curious instance of idiosyncrasy was recently witnessed in the person of a medical gentleman, (Mr. Crawford, late of Southampton,) who, while labouring under phthisis, was advised to try the prussic acid. He took a mixture containing only three drops, which raised the pulse 'from 96 or 100, its usual rythm, to 150, and it never fell below this afterwards, till his death. We only saw him a few days before his decease, and his first words were—“I have been poisoned by prussic acid." †M. Husson. Annuaire Medico-Chirurgical. sion was now determined on. A bandage was well applied, and drawn tighter as the size of the abdomen diminished. Under the influence of this new measure the urinary secretion increased-the volume of the abdomen diminished, and all sense of fluctuation soon disappeared. On the 6th of May, the patient left the hospital completely cured, and has since retained good health." It is needless to observe that, bandages are always applied after paracentesis abdominis; but rather with the view of supporting the abdominal viscera after the removal of the water, than from expectation of their preventing effusion, or promoting the absorption of a fluid effused. They are not, in general, applied with that degree of tightness, or kept uniform enough to answer the latter purposes. The measure is, therefore, deserving of attention. 14. Ovarian Dropsy cured by Operation. This was a very bold operation, and verified the proverb-fortuna favet fortibus. We shall give the history of the complaint, and the operation in 'our author's own words.. "Mrs. Strobridge, aged 33. Seven years before, she perceived a small tumour in her right side, situated in the right iliac region; when about the size of a goose egg, she could move it with her hand to the opposite side of the linea alba, and to some distance above the umbilicus. The patient had borne five children, two previous, and three subsequent to her discovering the tumour. The youngest child was 10 months old, and was nursed at the breast when she submitted to the operation. Soon after her first pregnancy, from the commencement of the tumour, and when, as she thinks, it was about 4 or 5 inches in diameter, it suddenly disappeared, probably burst into the abdomen. In 4 or 5 weeks it was as large as before. Before and after the bursting of the tumour she had turns of faintness, which lasted from two hours to half a day. During parturition of her second child, after the commencement of the tumour, it having acquired a considerable size, it burst again, and nothing was perceived of it till eight months had elapsed. In four days from its reappearance it was as large as it had ever been. It was again burst by a fall; great soreness of the abdomen, and confinement of the patient for several weeks was the consequence. The tumour filled again in a fortnight, and from this time continued to increase; it did not burst in the delivery of her last child, which was ten months previous to the operation. The patient's health was not much affected by the tumour. She was costive; and the size of the tumour incommoded her in the ordinary duties of her family, especially in stooping. On examination I found a large tumour in the right side of the abdomen; it was considerably moveable, and I could produce a distinct fluctuation through it. • Amer. Med. Recorder, No. 17. "Having decided on the operation, and determined the mode of operating, on the 5th of July, in the presence, and with the assistance, of Doctors Lewis, Mussy, Dana, and Hatch, I commence the operation as follows: "The patient being placed on a bed, with her head and shoulders somewhat raised, an assistant rolled up the tumour to the middle of the abdomen, and held it there. I then commenced an incision about an inch below the umbilicus, directly in the linea alba, and extended it downwards three inches. I carried it down to the peritoneum, and then stopped till the blood ceased to flow, which it soon did. I then divided the peritoneum the whole extent of the external incision. The tumour, now exposed to view, was punctured; a canula introduced, and seven pints of a dark coloured ropy fluid was discharged into a vessel; about one pint was spilt, so that the whole fluid was about eight pounds. Previous to tapping the tumour, by inserting my finger by the side of it, I ascertained that it adhered to some extent to the parietes of the abdomen, on the right side, between the spine of the ilium and false ribs. After evacuating the fluid I drew out the sack, which brought out with it, and adhering to it, a considerable portion of the omentum. This was separa. ted from the sack with the knife; and two arteries, which we feared might bleed, were tied with leather ligatures, and the omentum was returned. By continuing to pull out the sack, the ovarian ligament was brought out, this was cut off, two small arteries, secured with deather ligatures, and the ligament was then returned. I then endeavoured to separate the sack from its adhesions to the parietes of the abdomen, which occupied a space about two inches square; this was effected by a slight stroke of the knife at the anterior part of the adhesion, and by use of the fingers. The sack then came out whole, excepting where the juncture was made, and I should think it might weigh between 2 and 4 ounces. The incision was then closed with adhesive plaster, and a bandage applied over the abdomen. No unfavourable symptoms occurred after the operation; in three weeks the patient was able to sit up and walk, and has since perfectly recovered. -- "I was induced to undertake this operation from the following considerations : The patient, though her health was not greatly impaired, was sensibly affected by the disease. She was quite certain that the increase of the tumour, in a given time, was augmented; probably, at no very distant period, it would destroy her. I had, also, an opportunity to dissect the body of a patient, who had died of ovarian dropsy, after being tapped seven times. In this case the sack was found to be in the right ovarium, which filled the whole abdomen; but it adhered to no part except the proper ligament, which was no larger than the finger of a man. I have seen two other ovarian sacks which were taken from patients after death. They had been tapped several times; the sacks were equally unat tached, except to their own proper ligaments. Hence, I inferred, that in a case of ovarian dropsy, while the tumour remained moveable, it might be removed with a prospect of success. The mode of operating, practised in the above case, is the same as I have described to my pupils in several of my last courses of lectures on sur, gery. The event has justified my previous opinions." 15. Poisoning by Arsenic. A young married woman swallowed a quantity of arsenic near midnight, and next morning, at 8 o'clock, was found by Mr. Hume suffering the most excruciating torments, constant efforts to vomit, and "all the symptoms peculiar to the arsenical virus." It appeared that she had vomited once or twice rather copiously. Mr. Hume instantly prescribed the following mixture, viz. an ounce of carbonate of magnesia, a drachm and a half of vinum opii, three drachms of sp. lavand. comp. half an ounce of sugar, and sixteen ounces of distilled water. Two large spoonfuls were directed to be taken every ten minutes, while the symptoms continued violent. The first bottle produced a remission of the symptoms, and the second bottle seemed to have effected a cure. It is to be regretted that Mr. Hume's avocations should have prevented him from ever visiting the patient after the first time, till she came to him on the 5th day after the accident. What share the magnesia may have had in counteracting any arsenic that might have been remaining in the stomach, or the effects of the arsenic, if already disgorged, we leave to the determination of our readers. For our own parts, we are rather sceptical on this occasion, since the case is hurried over, and brought at last to a somewhat impotent conclusion. Mr. H. however, has promised farther particulars, and to these we shall revert, if they appear in time. P. S. In the succeeding number, Mr. Hume resumes his narrative; but now the cure is attributed to magnesia and opium. In this second paper our author flies from subject to subject with such astonishing rapidity, that we frequently lose sight of him entirely; in short we are quite incapable of deciphering what Mr. Hume would be at. We cannot but join with Mr. Hume in the following sentiment:- "I regret that this woman's case had not fallen into other hands, and that more attention on my part could not be bestowed to render it more complete. I visited her not more than three times, and these were not daily; so that the progressive state of the pulse and many other particulars are evidently wanting." We have the highest respect for Mr. Hume as a scientific chemist, but his best friends will acknowledge that he makes no great figure out of his own department. * The author, at the time of reporting the above case, was ignorant that Dr. Dzondi had proposed the attempt to cure ovarian dropsy by the introduction of a tent following puncture, that the dropsical sack might slough, and be withdrawn by forceps.-Vid. Medical Recorder, Vol. III. p. 63. ↑ Mr. David Hume.-Lond. Med. Journ. 273 16. Tympaniles. Professor Liquiere informs us that it was the successful treatment of this case that first brought him into notice at Autun, and laid the foundation of his renown, at a time when a host of circumstances combined to render his establishment in practice almost hopeless. Our readers will naturally be curious to know what this tide was that led him on to fortune. It was as follows. A man, 30 years of age, and previously healthy, was seized, in the year 1814, with violent colic, obstinate constipation, great eructation of wind, considerable distention of the abdomen, the violence' of the pain leaving him no intervals of repose. In a day or two, however, the constipation gave way spontaneously-a diarrhoea came on-and the complaint disappeared. At the end of a few days the colic returned, and the pain was more violent than ever. Various means were now tried for the removal of the complaint, as purgatives, liniments, potions, lavements, baths, blisters, &c. but without effect. Our author was then called in, the patient having been ill 22 days, during which no passage by stool had been procured. Dr. L. found the patient meagre and emaciated, the eyes hollow and expressionless, tongue dry and red, no thirst, great difficulty in swallowing, breathing free, great eructation, constant crying out with pain, pulse feeble but not frequent, the whole body in a state of marasmus except the abdomen, which was swelled and tense as a drum, very little sensible to pressure, and sonorous on percussion; the intestines so inflated that their course could be distinctly traced through the integuments; borborygmi so loud that the neighbours were firmly persuaded some living animal was in the patient's abdomen; constipation of 22 days standing; nourishment one cup of bróth daily. The patient had made several attempts to destroy himself. Dr. L. here falls into a long train of reasoning on this case, or as he terms it, “a mental analysis" of the pathological elements that entered into its composition. The primitive elements he at last reduced to two-pain and spasm. He makes it out (to his own satisfaction at least) that of these two the pain was the original and the spasm the consequence of pain. This is curious reasoning, for what is pain but the sense of some other morbid state? Is it not far more likely that the pain was the consequence of spasm? Be that as it may, he hit on the right therapeutics. He gave the patient, on the spot, a grain and a half of opium. This was at noon; and at one o'clock the dose was repeated, which removed the pain like a charm, and threw the poor fellow into a sound sleep of three hours. On awaking the pain returned, but with less violence, the constipation and abdominal tension remaining the same. The opium was repeated, and again the patient fell into a profound sleep. In the, morning he complained not of pain; and now a purgative injection of salts, manna, &c. was administered. Presently the patient felt an inclination to stool, and now "la scène excrementitielle comVol. III. No. 9. 2 C • Professor Liquicre. Journ. Compl. Oct. 1821. |